The Patient Encounter
This first step of the patient interview includes welcome, introduction, ensuring privacy, and patient comfort
What is setting the stage?
Mr. Garcia's symptoms began after failing an exam. Adjustment disorder symptoms must begin within this amount of time after an identifiable stressor.
What is within 3 months?
Dr. Randall emphasizes that this lifestyle factor is critical for long-term memory formation.
What is sleep?
Mr. Garcia specifically denied having these thoughts during his visit. (think negative)
What is suicidal ideation?
One of the four tenets of osteopathic medicine states that these two concepts are interrelated at all levels
What are structure and function?
After setting the stage, this step helps determine what concerns the patient wants to discuss during the visit.
What is obtaining the agenda?
Mr. Garcia reports two hallmark emotional symptoms that led Dr. Randall to diagnose adjustment disorder with mixed anxiety and depressed mood.
What are anxiety and depressed mood?
According to Dr. Slater's framework, nourish, move, rest, restore, and this final concept make up the five key lifestyle medicine concepts
What is connect? (or social connection)
This symptom causes Mr. Garcia to withdraw from his classmates' Thursday night basketball games.
What is loss of energy (fatigue)?
The founder of osteopathic medicine was inspired to develop a new approach to healthcare after experiencing this personal tragedy (you can name any)
What were the deaths of his children from meningitis?
Mr. Garcia presents concerned about not sleeping well and feeling overwhelmed. These concerns would be documented in this portion of the medical history
What is the chief concern (if said complaint only worth half :D)
Difficulty sleeping, poor concentration, and heart palpitations are examples of what type of adjustment disorder findings?
What are physical or stress-related symptoms?
Memory consolidation occurs in these three stages.
What are encoding, storage, and retrieval?
When thinking about school, Mr. Garcia experiences lightheadedness and this cardiovascular symptom.
What are palpitations (heart pounding)?
Dr. Randall encourages Mr. Garcia to use deep breathing, meditation, and yoga as examples of these.
What is Mind-body techniques?
When Mr. Garcia reports feeling stressed, tired, and unable to concentrate, these are examples of this type of data.
What is subjective data?
Which of Mr. Garcia's vital signs is at the high end of the normal range and may reflect his anxious state? (value)
What is a heart rate of 90 bpm?
Mr. Garcia reports difficulty remembering material he recently studied. The brain structure most associated with short-term memory formation is this.
What is the hippocampus?
This anxiety disorder should be considered in the differential diagnosis when symptoms resemble adjustment disorder.
What is generalized anxiety disorder (GAD)?
According to evidence-based practice, healthcare decisions should integrate the best available evidence, patient values, and this third component.
What is clinical expertise?
According to the interview framework discussed in FIT Week 1, the four early steps of the encounter are setting the stage, obtaining the agenda, identifying the chief complaint, and this final step.
What is beginning the interview?
Before concluding that adjustment disorder is causing Mr. Garcia's symptoms, Dr. Randall orders laboratory testing to rule out conditions such as these endocrine disorders.
What are hypothyroidism and hyperthyroidism? (other differential diagnoses are acceptable too :D )
A medical student (probably me fr) can remember anatomy facts but cannot remember learning them in lecture. These two memory types are both classified as explicit memory.
What are episodic and semantic memory?
A key diagnostic feature that separates adjustment disorder from many other psychiatric conditions is the presence of this.
What is an identifiable stressor that precedes symptoms?
Name any three sources of evidence that support evidence-based practice.
What are clinical practice guidelines, systematic reviews/Cochrane reviews, randomized controlled trials, and shared decision-making?